Faecal Lactoferrin- A novel test to differentiate between the irritable and inflamed bowel?

Gastroenterology & Liver Unit, Royal Hallamshire Hospital, Glossop Road, Sheffield S102JF, United Kingdom.
Alimentary Pharmacology & Therapeutics (Impact Factor: 5.73). 03/2010; 31(12):1365-70. DOI: 10.1111/j.1365-2036.2010.04306.x
Source: PubMed


Distinguishing between inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS) can be challenging.
To investigate the utility of faecal lactoferrin as a marker of inflammation in patients with IBD, IBS and controls.
Disease activity in IBD patients was assessed using the modified Harvey-Bradshaw Activity Index. Stool samples were analysed using an ELISA assay.
We recruited 137 patients with IBS, 126 with ulcerative colitis (UC) and 104 with Crohn's disease (CD), and 98 healthy volunteers. The median +/- IQ lactoferrin concentration (microg/g faecal weight) was 0 +/- 1.4 for IBS patients, 6.6 +/- 42 for UC patients, 4 +/- 12.7 for CD patients and 0.5 +/- 2 for healthy controls. Lactoferrin levels were significantly higher in IBD patients compared with IBS/healthy controls (P < 0.001). The median lactoferrin concentrations were significantly higher in active UC & CD patients compared with inactive patients (P < 0.001 and P = 0.002 respectively). The sensitivity, specificity, positive and negative predictive values of lactoferrin in distinguishing active IBD from IBS/healthy controls were 67% and 96%, 87% and 86.8% respectively.
Lactoferrin is useful to differentiate between IBD and IBS, and can be used as an adjunct to blood parameters to determine IBD patients who have ongoing inflammation.

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Available from: Mark E Mcalindon,
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    • "Although more work needs to be done, parallels can be seen in studies of inflammatory bowel disease. In inflammatory bowel disease, lactoferrin SNPs in different alleles affect different ethnicities and different genders in their susceptibility to disease (Sidhu et al. 2010). In effect, less lactoferrin will lead to more LPS TLR-stimulated cytokine activity (Elass- Rochard et al. 1995). "
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    • "One study found that mean FL level was similar in patients with IBS and healthy control; that study combined these two groups for comparisons with patients with IBD [10]. Another study only reported the TP, FP, TN, and FN rates of FL assay in distinguishing active IBD from IBS [14]. As our aim was to observe the diagnostic performance of FL in differentiating IBD from IBS, our meta-analysis included 1012 patients, 609 with IBD, 381 with IBS and 22 healthy volunteers. "
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    ABSTRACT: Background To perform a meta-analysis evaluating the diagnostic ability of fecal lactoferrin (FL) to distinguish inflammatory bowel disease (IBD) from irritable bowel syndrome (IBS). Methods The Medline, EMBASE, Web of Science, Cochrane library and CNKI databases were systematically searched for studies that used FL concentrations to distinguish between IBD and IBS. The sensitivity, specificity, and other diagnostic indexes of FL were pooled using a random-effects model. Results Seven studies, involving 1012 patients, were eligible for inclusion. In distinguishing IBD from IBS, FL had a pooled sensitivity of 0.78 (95% confidence interval [CI]: 0.75, 0.82), a specificity of 0.94 (95% CI: 0.91, 0.96), a positive likelihood ratio of 12.31 (95% CI: 5.93, 29.15), and a negative likelihood ratio of 0.23 (95% CI: 0.18, 0.29). The area under the summary receiver-operating characteristic curve was 0.94 (95% CI: 0.90, 0.98) and the diagnostic odds ratio was 52.65 (95% CI: 25.69, 107.91). Conclusions FL, as a noninvasive and simple marker, is useful in differentiating between IBD and IBS.
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